Source: Philadelphia Inquirer Contact: 1 Dec 1997 Website: http://www.phillynews.com/inquirer/ PICKING JUNKIES' BRAINS FOR RESEARCH Penn Psychologist Hopes That Learning About Craving Can Help By Alfred Lubrano, Inquirer Staff Writer Drug addicts from the street stumble into the welllighted labs of the University of Pennsylvania to watch movies about junkies getting high. "Good stuff," one celluloid "crackhead" tells another in the film, as his head snaps back with a smoking hit from a hotburning pipe. "Yeah, feels all right," his buddy responds, the rush of headringing molecules seemingly grabbing hold. For the nonaddict, the crack film with men only pretending to smoke dope is a thumbsdown effort with decent acting but no story line, and just one, interminable scene of two guys at a makebelieve good time. But for the hooked user, it's "Citizen Kane Goes To Jurassic Park On Independence Day," an alltime boxoffice event. When addicts see people abusing drugs, it kicks off craving a profound state of desire stronger than sexual arousal, says psychologist Anna Rose Childress, who studies the brain basis of addiction craving. On hiatus from their wrecked lives, the ragged corps of strungout people who troop to the Penn cinema provide scientists such as Childress entree into their heads. Crack and heroin addicts are shown the films while they are in a PET (positronemission tomography) scanner, which pinpoints brain activity. In exchange for their help, Childress and her colleagues treat the addicts. Childress can peer into brains and literally see the seat of desire, the wantingplace inside addicts that orders them to abandon jobs, children and spouses to hunt for mindspiraling product. The hope is that from these unusual teamings of addicts and doctors will come a heightened understanding of drug craving, and perhaps development of anticraving medication to end relapses. It's all cuttingedge stuff, and Childress, a 45yearold softspoken, athletic Ph.D. from Appalachia with a weakness for chocolate, explains the science by referring to a drawing of the brain that her daughter Amelia did when she was 6. Not content to be a mere lab rat, stuck in an ivory tower, Childress will go anywhere for her work, with sometimes unforeseen outcomes. Not long ago, she and some former heroin addicts were driving around West Philadelphia in her white Volvo, making a movie about shooting up. They were so convincing, the police stopped them and demanded to know what was happening. "Dr. Childress is like nobody else," says a former heroin addict who was successfully treated by Childress, and who helped her make the copinterrupted heroin film. He asked that his name not be used. "She really wants to help people, and when she asked me to do the film, it made me feel like I was doing something to keep others from this drug life that no one should have to live." The addictscientist alliance works, the former addict and others say, because Childress is so affable. Intellectually rigorous in her research, Childress is also a warm and empathetic ally for addicts. One recent day she showed up to work with a backpack full of brain scans, notes for an academic article she's writing and a waffle iron to make pear waffles for her colleagues and any patients who happened by. Her work is generating enough buzz to have landed her on Nightline and 20/20 several times. She will also be the focus of a Bill Moyers PBS program on addiction scheduled to air April 8. "Addiction is one of the very toughest things in the world," Childress says. "The patients see we want to treat and help them, and not just use them in research." Craving is insidious. The smell of burned matches, the sight of a $10 bill (the price for a dime bag of drugs), even those "Just Say No" posters with a crossedout needle, all act as potent cues that could bring even longclean addicts to their knees, screaming for dope. Childress has long known that telling people who relapse that they have no willpower is feeble counsel. For years, the definition of addiction was physical dependence followed by observable withdrawal. Heroin always has had a colorful withdrawal state that included flulike illness. And, without intervention, alcohol withdrawal could kill a person. People kept taking these drugs to quell the sick feelings they had when they stopped dosing. But cocaine didn't seem to come with the same kind of withdrawal; you don't get ill when you're not high. So scientists dismissed cocaine addiction as being merely psychological, not physiological. But Childress has learned that drugs like cocaine have an incredible draw to them. Cocaine addicts are pulled by the anticipation, or craving, rather than pushed by withdrawal, she says. Cocaine addicts seeing Childress' movie report tasting cocaine in the backs of their throats. "Their hearts pittypat, they get lightheaded, some even experience a minor euphoria," she says. "We're stuck with a wonderful brain that's wired to pursue things that are pleasurable, because those are the things that allow us to survive as a species," Childress says. "And that system encourages you to repeat what activates you. We're prisoners to it." When addicts see the films, the pleasure centers in their brains light up. The PET scan detects where the brain is working hardest where it's active. That's proof of a physiological not merely psychological component to craving. "There's a physical, brain basis to it all," Childress explains, pointing to Amelia's drawing. Greg Scirotto's brain sits gray and still, like the first pictures from a dead planet. PET photos of his head have helped Childress understand how cocaine can tear apart a life, cell by cell. Somewhere among the abused neurons of Scirotto's brain is his former life. Friends and family chased by the crack and outrageous behavior exist as neurochemical flickers in the part of Scirotto's brain where memories and regrets get warehoused. A former senior account executive with WWDB radio, Scirotto, 45, of Ardmore, smoked up his car and his savings and alienated his family. "I was out of chips when I went to Anna Rose," Scirotto says. "I was a guy on a raft, drifting from land." In exchange for drug treatment, Scirotto allowed Childress to look inside his head. She popped him in the PET scanner, and showed him a series of movies. First, hummingbirds, waterfalls, horses and other nature films. His brain scan never lit up. Then, Childress ran the movie of the guys smoking crack. Red lights. "It makes your heart race," Scirotto says. "It stimulates you. It's not a Hollywood movie. It was like watching the real thing. It's a very accurate film." Now he's clean, and the blues don't push him to smoke crack anymore. He's got his life back including his 16yearold daughter. Because so many addicts compare drug craving to sexual desire, Childress asked her young colleagues to put together a sex film from various adult movies. She wanted to see whether the same parts of the brain that get lit up in the PET machine during drug movies are activated during sex films. Childress got volunteers to lie in the PET scan for 86 minutes, watching people have sex. It looks as if she was right sex and drug craving are seated in the same part of the brain. Though she shot and edited the drug films, Childress was shy about the sex film and has never seen it. She'll tell you that there are limits, even for dedicated brain scientists. Still, her work will continue. She explains it simply: "I am obsessed with craving."